Not a NICE CT protocol for the acutely head injured child
Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK. Clinical Radiology
(Impact Factor: 1.76).
03/2008; 63(2):165-9. DOI: 10.1016/j.crad.2007.05.027
To assess the impact of the introduction of the Birmingham Children's Hospital (BCH) head injury computed tomography (CT) guidelines, when compared with the National Institute of Health and Clinical Excellence (NICE) guidelines, on the number of children with head injuries referred from the Emergency Department (ED) undergoing a CT examination of the head.
All children attending BCH ED over a 6-month period with any severity of head injury were included in the study. ED case notes were reviewed and data were collected on a specifically designed proforma. Indications for a CT examination according to both NICE and BCH head injury guidelines and whether or not CT examinations were performed were recorded.
A total of 1428 children attended the BCH ED following a head injury in the 6-month period. The median age was 4 years (range 6 days to 15 years) and 65% were boys. Four percent of children were referred for a CT using BCH guidelines and were appropriately examined. If the NICE guidelines had been strictly adhered to a further 8% of children would have undergone a CT examination of the head. All of these children were discharged without complication. The remaining 88% had no indication for CT examination by either BCH or NICE and appropriately did not undergo CT.
Adherence to the NICE head injury guidelines would have resulted in a three-fold increase in the total number of CT examinations of the head. The BCH head injury guidelines are both safe and appropriate in the setting of a large children's hospital experienced in the management of children with head injuries.
Available from: Volker Hesselmann
- "If the cause of the trauma is not obvious, the patient should be admitted into a neurosurgical unit for adequate surgical treatment.9 Unclear neurological status should indicate that neuroimaging (eg, CT) is necessary, especially in children,19 and that additional imaging (eg, CT angiography, MRI) should be performed if needed. Reducing the risk of a neurological deficit is of the highest priority for the patient, and thus a diagnostic CT scan may be warranted. "
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ABSTRACT: In young people, traumatic head and brain injuries are the leading cause of morbidity and mortality. In some cases, no neurological deficits are present, even after penetrating trauma. These patients have a greater risk of suffering from secondary injuries due to secondary infections, brain edema, and hematomas. We present a case report which illustrates that brain injuries that do not induce neurological deficits can still result in a fatal clinical course and death, with medicolegal consequences.
A 19-year-old patient was admitted to hospital suffering from a head injury due to an assault. He reported that he was attacked from behind. Medical examination showed no neurological deficits, and only a small occipital wound. Neuroimaging of the cranium revealed that a knife blade was penetrating the cranial bone and touching the superior sagittal sinus.
After removing the foreign body, magnetic resonance imaging showed that the superior sagittal sinus remained open.
We want to stress that possible problems can arise due to the retention of objects in the cranium, while also highlighting the risk of superficial clinical examination.
International Journal of General Medicine 10/2012; 5:899-902. DOI:10.2147/IJGM.S35925
Available from: ajronline.org
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ABSTRACT: The purpose of this study was to focus attention on the technique factors commonly used in survey CT scans (e.g., scout, topogram, or pilot scans) to measure the radiation exposure from typical survey CT scans, to compare their exposure to that of typical chest radiographs, and to explore methods for radiation exposure reduction.
The default survey CT scans on 21 CT scanners, representing three different vendors and 11 different models, were investigated. Exposure measurements were obtained with an ion chamber at isocenter and adjusted to be consistent with standard chest radiographic exposure measurement methods (single posterior-anterior projection). These entrance exposures were compared with those of typical chest radiographs, for which the mean for average-sized adults is 16 mR (4.1 x 10(-6) C/kg).
The entrance exposures of the default survey CT scans ranged from 3.2 to 74.7 mR (0.8 to 19.3 x 10(-6) C/kg), which is equivalent to approximately 0.2 to 4.7 chest radiographs. By changing the default scan parameters from 120 kVp to 80 kVp and the tube position from 0 degrees (tube above table) to 180 degrees (tube below table), the entrance exposure for the survey CT scan was reduced to less than that of one chest radiograph for all CT scanners.
For institutions at which the interpreting radiologists do not rely heavily on the appearance of the survey CT image, we recommend adjusting the technique parameters (kilovoltage and X-ray tube position) to decrease radiation exposure, especially for vulnerable patient populations such as children and young women.
American Journal of Roentgenology 09/2005; 185(2):509-15. DOI:10.2214/ajr.185.2.01850509 · 2.73 Impact Factor
Available from: Keith J Strauss
American Journal of Roentgenology 03/2008; 190(2):273-4. DOI:10.2214/AJR.07.3526 · 2.73 Impact Factor
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